by jennb4576 » Mon Nov 10, 2008 09:21 pm
I was told by my chiropractor that in some states, you do not have to pay back the medpay you used. I didn't think that I could keep the money that should have been paid back to my insurance co for my medical expenses due to my accident, which I was not at fault. Does anyone have any information on this topic? The state in question would be Iowa
Posted: Wed Aug 12, 2009 12:41 pm Post Subject:
It truly depends on your state. Here in PA they did subrogate. It was a forever process. In the end they could not get highmark to even respond half the time. After my settlement they (atty) put the medical monay highmark claimed I owed aside wating to see if they would agree to a lesser amount. After a few months they released the funds to me advising me highmark had the right to collect it in the future. Eventually the did agree to the lesser amount and I sent the money back to the atty. I would be sure of what was going on because this can be tricky depending on your state.
Posted: Thu Aug 26, 2010 12:11 pm Post Subject: med pay
please advise if Blue Cross Blue Shield has the right to put a lien on my settlement with the third party carrier in the state of VA. I was told that you can treat with your health insurance and also collect your med pay.
Please let me know, because I read the statue for VA Law which is 38.2.2209 which indicates that med pay is not subrogatable.
Posted: Thu Aug 26, 2010 12:23 pm Post Subject: is med pay subrogatable in VA
please advise if Blue Cross Blue Shield has the right to put a lien on my settlement with the third party carrier in the state of VA. I was told that you can treat with your health insurance and also collect your med pay.
Please let me know, because I read the statue for VA Law which is 38.2.2209 which indicates that med pay is not subrogatable.
Posted: Thu Aug 26, 2010 06:43 pm Post Subject:
"Medical Payments" in an auto policy, if that's what you're talking about, is EXCESS coverage -- it would pay only if your medical insurance does not, or if you chose not to use your medical insurance. This coverage is for you through your own auto policy.
On the other hand, if you are collecting on a claim for personal injuries from a third party, and your medical insurance has already paid medical expense claims for those "damages", then the medical insurance company DOES have the right to subrogate that claim, perhaps even the ability to place a lien on your settlement.
If nothing else, they have a claim against your third party settlement, and can come after you for the money they paid on your behalf.
Posted: Wed Jun 15, 2011 08:50 pm Post Subject: lst party medicaid subrogation.
My medicaid paid my accident bills. There were 8 claimants. Liability was not enough for all claimants. Pip is available. This is in S.C. Pip carrier wants to only pay what was paid by medicaid. I have an agreement on mediciad lien and will pay. Is pip carry allowed to only pay the amount of medicaid lien and not the full medical bills?
Posted: Wed Jun 15, 2011 08:50 pm Post Subject: lst party medicaid subrogation.
My medicaid paid my accident bills. There were 8 claimants. Liability was not enough for all claimants. Pip is available. This is in S.C. Pip carrier wants to only pay what was paid by medicaid. I have an agreement on mediciad lien and will pay. Is pip carry allowed to only pay the amount of medicaid lien and not the full medical bills?
Posted: Wed Jun 15, 2011 10:10 pm Post Subject:
If Medicaid paid your medical expenses, the amount paid by Medicaid is all that the state can recover from your PIP. You cannot receive the difference between that and some other amount of money. Those paid amounts are your expenses, nothing more, nothing less.
Posted: Wed Oct 05, 2011 10:38 pm Post Subject: Med Pay - Very Confused
I have a high deductible health insurance policy - $5000 deductible.
When we got this policy, we also bought extra Med Pay on all drivers/cars in the family (5) for $5000 each. We figured this way we were protecting ourselves in the even of an accident which might cause us a financial burden of $5000 deductible all at once.
So, my oldest was in an accident a few weeks ago - he was actually driving SOMEONE else's car (his had a dead battery). He was HIT by a drunk driver (so not his fault at all). Sadly, though, the drunk driver did not have insurance and the owners of the car my son was driving only had a very small liability only policy.
My auto insurance says I can file a claim and get the med pay because it covers my son whether he's driving his car or someone else's.
However, The hospital doesn't want to file with our Health Insurance - they want to file directly with our auto insurance and claim this is the LAW.
Thing is, the bill totals about $12000. If they file with the health insurance, the health insurance will pay 80% of $7000 (the $5000 deductible will be met first). Then I can file my med pay, get the $5000 and pay the hospital the remaining balance. My total out of pocket will be $1200. (12000 - 5000 = 7000; 7000 * 20% = 1200).
BUT, if the hospital forces me to make a claim on my auto policy med pay FIRST, then they will get that $5000 up front, THEN they will bill my health insurance for the remaining 7000 - of course, at the point, my health insurance will apply the 5000 deductible, leaving me a MUCH BIGGER BILL - $5400!!
Now, how can this be legal and justifiable? **I* pay EXTRA for MY med pay to protect ME - not to protect the health insurance companies....Also, the hospital has a dog in this hunt, too....see, if they go for the med pay first, they don't have to "settle" for contract rates with the health insurance company (Typically health insurers have contracts with hospitals/doctors, etc., that substantially reduce the amount they will pay for procedures - but if the hospital goes through my auto insurance, they stand to make MORE $$ because there is no contract for these services with my auto insurance and they can get the full $ amount). This seems like a racket to me???? How can this be legal? And if so, why would ANYONE voluntarily carry extra MED PAY insurance when it doesn't even protect you?
Posted: Thu Oct 06, 2011 04:30 am Post Subject:
There are a couple of things you need to understand about health insurance vs. auto insurance.
First, health insurance is coverage for FIRST PARTY claims. You/your spouse & dependents are the first parties. The insurance company is the second party. Your insurance pays for your own health/accident claims unrelated to any other party. It is not intended to pay for third-party claims -- your bills caused by someone else's negligence.
The hospital is doing the right thing by not filing the claim with your health insurance company first. And they have the legal right to collect 100% of their actual expenses. But they should not be filing the claim with your own auto insurance company first either. The expenses are the responsibility of the party that caused the collision -- the drunk driver. OK, so he has no insurance. That doesn't relieve him of the responsibility to pay. The hospital should send that person a copy of the expense ledger.
Because a fourth party's vehicle is involved, that adds another dimension to the claim. If the owner of the vehicle your son was driving has Uninsured Bodily Injury Liability (UMBI) coverage, it will pay your son's medical expenses. You can leave your own auto insurance out of the discussion for the moment. There is probably not a legitimate claim against that person's Bodily Injury Liability (BI) coverage, but you can still make it and wait to see what transpires..
Your own auto insurance is a combination of first party coverage (damages you cause to your own property) and liability coverage (damages done to others). For example, your collision coverage pays for damage you cause to your own vehicle. Your Bodily Injury Liability coverage pays for damages done to others who are not a member of your own household. It does NOT cover your own bodily injuries. But your MED PAY does. It is payable over and above other insurance coverage, although it may be subrogatable to your health insurance company. So you can file a MED PAY claim for the $5,000 deductible expense since it is not covered by other insurance.
And you can also file a claim against your own UNINSURED/UNDERINSURED bodily injury coverage, if you have it (but you would want to claim under the other vehicle owner's policy first). Those payments are definitely subrogatable against your medical insurance. That is, if your medical insurance pays 80% of $7,000 (or $5,600) you can collect the full $12,000 from the UMBI, but will have to reimburse the health insurance company the $5,600 it paid for a third-party claim.
why would ANYONE voluntarily carry extra MED PAY insurance when it doesn't even protect you?
This is a legitimate question. The answer to this has more to do with protecting others who ride in your vehicle, than it does with you/your dependents. If you are carrying a passenger and are involved in a collision, your fault or not, the MED PAY is waiting there with a small, finite amount of money ($3,500 - $5,000) that will be paid upon presentation of a bill for medical services. If you NEVER have a passenger in your vehicle, and have health insurance, and cause your own injuries, your health insurance will cover that loss according to the terms of its contract with you. If your injuries are caused by a third party, your loss is the responsibility of the third party.
Add your comment